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Individual
KENDRICK JACKSON
Active
Individual
KENDRICK JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
LA
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
LA
101YM0800X
Mental Health Counselor
—
LA
101YP2500X
Professional Counselor
—
LA
103K00000X
Behavior Analyst
—
LA
103TC2200X
Clinical Child & Adolescent Psychologist
—
LA
103TR0400X
Rehabilitation Psychologist
—
LA
104100000X
Social Worker
—
LA
1041C0700X
Clinical Social Worker
—
LA
106H00000X
Marriage & Family Therapist
Primary
—
LA
Other
Enumeration date
07/17/2015
Last updated
07/17/2015
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